What Makes Good Street Outreach in the Era of Coordinated Entry?

Once upon a time, a person curled up like a question mark on the sidewalk resulted in our best guess of what should be done. With coordinated entry come opportunities to use data in different ways to better inform street outreach, and ensure integration with the rest of the homeless service delivery system.

Here are seven pointers to help you along the way:

1. Street outreach is not an entry level position

Most communities have two groups of people that are amongst those with the highest acuity: persons that have been in shelter for long periods of time, and persons that live outside and do not use shelter or only use shelter on seldom occasions. While it would seem obvious that your most acute persons experiencing homelessness would benefit from your best trained and most experienced personnel, time and again communities see outreach as an entry level position, or something that untrained peers can do. If you want to get highly acute persons integrated into your coordinated entry system, think through the staff you need doing outreach for this to get the desired outcome.

2. You must balance your priority list with new contacts

Street outreach is planned, strategic, and organized. It is not an activity of driving or walking around aimlessly happening upon homeless persons by chance. In a coordinated entry system, street outreach should know exactly which people they aim to connect with daily, for what purpose, and with a strong housing orientation. Three quarters or more of every shift should be spent with existing contacts and moving the housing process forward. Only about a quarter should be spent with new contacts. As for where the priority list comes from, this is most often determined through a Point in Time Count, or periodic population surveys done once every two or three months. Everyone on the priority list is known by name, acuity level, and location of where most commonly located. Mapping can be helpful, even if it is a simple pin drop on Google Maps. Along the way you will come to distinguish the difference between your anchors (same people in generally the same spot night after night) and your tumbleweeds (people that are genuinely drifting through, or more fluidly using shelters and other resources as well as outreach).

3. The same tool used for common assessment elsewhere in your community must be used in a mobile manner

There is not one triage or assessment tool used in shelters and housing programs, and a different one used through street outreach. Moreover, street outreach workers either need to have the skills and training to deliver the tool, or else assessment staff need to ride along with street outreach workers several times per week. Trying to have street outreach workers transport people to where an assessment can occur is an unnecessary barrier.

4. Balance outreach across different times of the day

Some street outreach has to occur during the day because that is when most government services and other service providers and housing providers are operating. However, it is a mistake to do outreach only during the day, as there is insufficient engagement with some of the most street involved and entrenched persons that are undetectable during daytime hours.

Some street outreach has to occur in the evening and nighttime because that is when most people living outside are bunking down or are engaged in nocturnal activities. However, it is a mistake to do outreach only during the evening or night, as there is insufficient connection to activities that can only happen during the day.

Some street outreach has to occur in the early morning hours and around the crack of dawn because that is when most persons that bunked down for the night are rising, and because some of the persons that were incapacitated because of their nocturnal activities are lucid (though perhaps feeling rough).

This does not mean your community has to have three street outreach teams. But it should result in different shifts from week to week to week in order to maximize coverage of times of day to connect with people to ensure maximum impact.

5. Don’t confuse building rapport with people liking you

Street outreach workers are effective when they build rapport through professional skills and the ability to deliver on what they offer: housing. Street outreach workers do not need to be chummy. They do not need to hand out cigarettes or sandwiches or coffee to engage and be effective. They need to have a clear offer of housing with appropriate follow through. Time and again we have seen it possible for an individual on the street to absolutely despise a street outreach worker and still get housed through their efforts.

6. Ensure a warm transfer to ongoing supports in housing

In a coordinated entry system the interface between the engagement point (streets) and the resolution of homelessness (housing) is wrought with cracks people can fall through. This is especially true when blind referrals are made (which is about telling people where to go and at which time and hoping it happens rather than actually accompanying people). Part of effective street outreach is ensuring there is a gradual, warm handoff to the longer term housing case manager. Street outreach workers should also visit people in their housing for the first few weeks after move-in to reinforce the transition and provide a support to the work being completed by the individual and the housing case manager.

7. Never drift away from a Housing First orientation in your approach

Street outreach must focus on getting people off the streets and into housing, without jumping through unnecessary hoops like attending programs, going to treatment, obtaining an income first, taking medications, demonstrating sobriety, or being assessed for housing readiness. Street outreach also needs to focus on ensuring there is movement into housing, not building dependency or enabling people to stay on the street. I am of the opinion that only the most rare of circumstances should survival gear like food, tarps, sleeping bags or the like be shared with persons living outdoors – and in some communities there is no place for this at all.

Street outreach workers, depending on the community, can be critical to a lot of the administrative work required for people to get housing. This can include things like getting identification for the person they are supporting, filling out paperwork for housing providers, collecting verification documentation, etc.

Street outreach workers are getting people to commit to a support program that comes with housing, not a housing program that comes with supports. Street outreach must never lead people to believe that there is an offer of housing only. This ensures that street outreach is effectively supporting the coordination process of ensuring long-term housing success for persons with higher acuity.

Confusion of Resources: Make Proven Practices Possible through Reinvestment

Invest in change. Spend on impact. (Re)Profile the resources in your community to meet needs. For many communities, this means figuring out how to fund rapid rehousing – or to scale up their rapid rehousing.

While not the case 100% of the time, those communities that struggle the most with figuring out how to make this happen are the ones that will not let go of anything they are currently doing – whether or not that is aligned with ending homelessness – and will entertain it if and only if they have new resources. Peel back the curtain, though, and you can often see opportunities to make rapid rehousing (and other things like expansion of PSH or housing-focused street outreach) if – and only if – the organization/community is brave enough and strategic enough to change what they have always done.

Let’s look at a few common examples:

• Scattered site transitional housing can be (relatively) easy to transform into a rapid rehousing program.

• Survival based street outreach that hands out socks, sleeping bags, tarps and the like would be better spent providing rapid rehousing directly from the street.

• Using homelessness and housing resources to fund substance use recovery programs (residential or otherwise), is essentially letting health and addiction funders off the hook, and misusing housing resources for treatment. Homelessness and housing resources could be spent on rapid rehousing. Yes, resources may be necessary for treatment, but don’t use your homelessness and housing resources to fund it.

• Extensive programming within shelters such life skills training, budgeting programs, socio-recreation programs, etc. are well intentioned but misplaced when in shelter. These resources would be better spent on rapid rehousing and providing these types of supports in community.

We do not provide services in an environment of unlimited resources. I have yet to find the community that feels they have more money or staff resources than they know what to do with, and therefore, need to make more intelligent and informed decisions on investing. Rapid rehousing is worth investing in. Don’t confuse where money has always been invested with where it should be invested.

The Unexpected (?) Kindness of People Experiencing Homelessness

Did you see the video where the kid is laying on the sidewalk and the only person to stop and offer warmth and comfort was a man that is homeless?

Did you read the news story where a woman that is homeless found a wallet – and returned it without taking any of the money or using the credit cards first?

Did you hear about the youth that is homeless that sang the song to the kid that was crying at the parade?

I like a feel-good, good-news story as much as the next person. What I cannot fathom is why the homelessness status of the individual is such a riveting point in the news story. It is as if people experiencing homelessness are incapable of being kind.

If you want to understand kindness, maybe you need to understand empathy first. I can share the feelings of another if I have felt those feelings myself. If homeless, it is natural empathy to provide warmth and comfort of another. It is natural empathy to return precious belongings of another if I, myself, have experienced things taken from me. It is natural empathy to help others find joy during periods of discomfort or frustration – as I long to feel the same.

People experiencing homelessness are – believe it or not news media outlets and sensational FaceBook status updaters – capable of the same range of emotions and housed people. You do not lose your capacity to have emotions when you experience homelessness. To think otherwise is to, perhaps implicitly, reinforce that if you are homeless you are an “other”…not someone’s mother, father, sister, brother, son, or daughter.

“In all my years of experience…”

Over the past decade the change movement in homeless services has been leaping forward exponentially. There is greater knowledge and acceptance of things like housing before treatment, coordinated entry, using assessment rather than subjective opinion, and overall, ending homelessness. But that does not mean there is always widespread acceptance. One of the greatest struggles in communities are those that have been set in their ways for decades that are unwilling or disinterested in new evidence or practices. This usually begins with a statement of “In all my years of experience…” followed by some explanation of why what is being suggested will not work.

Take, for example, a community I was working with in Florida. The Founder of a non-profit – now quite up in age – came to a meeting with CEOs and Executive Directors to hear me talk about changing homeless services towards a housing orientation rather than a treatment orientation. At the conclusion of my talk she chimed in with, “In all my years of experience people need to have their root issues like health issues and addiction issues dealt with before they can even think about going into housing.”

Or consider another example, from Central Canada when an older volunteer within a particular cultural group remarked, “I have been doing this type of work since long before you were born, sir, and I know for sure that unless the people in my community confront the evils of alcohol first they will never stay housed or build relationships that matter.”

Or one more example to ponder from a conference workshop I was giving in Michigan where the participant came up to me when the session was done and said, “That was the most exhilarating talk I have heard in a long time. It lit me on fire inside. But like all fires you have to be careful. Because you said some dangerous things about getting homeless people housed right away. There’s a reason we have shelters, son. They get people ready to succeed in the real world. Don’t forget that. I’ve been at this since the first shelter opened here. I know what works. In all my years of experience, no one in [insert name of city] would succeed doing what you talked about.”

So what is this all about?

First of all, we naturally equate longevity at an activity or job as success. It is entirely possible to be in the same profession for a long time and not be good at it. In fact, you could do it for a long time and be an uneducated fool. I would hope that is rare, but it is possible. And it may be more possible in the non-profit world or faith based organizations where people can confuse being well intentioned with being knowledgeable or effective.

Secondly, what is being presented is opinion. If it were informed opinion (evidence, data and scientific information combined with experience) these all may be very valuable contributions. However, they were essentially uninformed opinions (experience only – without the factual backbone) that was confusing their years of practice with evidence.

Thirdly, I would suggest that this is somewhat indicative of an industry that rarely embraces investment in ongoing professional development. Too often, citing the “we’re a poor non-profit” mantra, organizations fail to learn and misinterpret what they think with what they actually know.

Finally, I believe this can be indicative of a lack of oversight on the part of Boards of Directors. Each board should be satisfied that the organization they provide oversight to has the knowledge to do the work most effectively. Board Members should attend leading conferences on homelessness and housing, invite external speakers, and read published information on the subject. If they don’t, they may accept what they are told from the CEO or Executive Director as the absolute truth…when really it is absolute opinion.

Working to End Homelessness

oday’s guest blogger is Ali Ryder, a Planner with OrgCode Consulting.

This week, I had the privilege of being invited by the fine folks at Heartland Alliance to act as a coach at their Working to End Homelessness Innovation Workshop, part of their Connections Project.  It was a fantastic opportunity to meet with great people from across the country, who were all excited to try new innovative approaches to connect homeless people with employment!  I learned so much, but here are my top takeaways:

1. Everyone wants to break silos, but no one is 100% sure how to do it

A lot of project teams said that there were great housing programs in their community, and great employment programs in their community, but since they had different goals and funding streams, it was always identified as a challenge to get these programs to work together.

2. There are a lot more federal programs than people know about

Did you know that you can use Medicaid to help fund Permanent Supportive Housing?  Did you know that people on disability can work and still receive their benefits?  Did you know that there’s a program called the Family Self-Sufficiency program, operated by HUD that incentivizes low income families in RGI to increase their income without being penalized on rent, and that any housing providers (not just a housing authority) can implement the same program for their tenants?  Did you know that there’s a new HUD program called Jobs-Plus?  Or that there’s funding to help youth to expunge or seal their criminal records?  Or that HUD has a $15 million annual budget to provide technical assistance for communities?  I’m willing to bet you knew some of those, but not all!

3. “Collective Impact” is the new buzzword

“Collective Impact is the commitment of a group of actors from different sectors to a common agenda for solving a specific social problem, using a structured form of collaboration (definition from Wikipedia).” Okay, maybe it’s not so new, but isn’t getting everyone to work together a good thing?

4. There’s a lot of talent out there

The Innovation Workshop was just the top 10 teams from across the country, and they all had great ideas!  I’m sure not jealous of the team at Heartland Alliance that has to figure out which ones are the best of the best.

5. Engaging the business sector can be done, but it requires thinking a certain way

If you’re trying to engage regular business people with your program, you need to make sure you speak their language.  Instead of asking them for a favor (“please, just give this guy/gal a chance!”), turn the tables.  How are you helping them?  Maybe they’re a landlord or employer with a high turnover rate, and they don’t want to go through yet another hunt for a new tenant/employee.  Tell them how you are helping them save time and effort.  And then follow through – it doesn’t work if you make a promise and don’t deliver.

6. The ending homelessness realm is actually pretty progressive

You might not believe me, but think about this.  There was a way we used to do things, and then a couple people started trying to do things differently.  They called it Housing First.  It worked really well.  Other people tried it.  It caught on.  The federal government is behind it.  There’s funding changes that support evidence-based and evidence-informed best practices.  The HEARTH act is referred to as a “game-changer.”  We know things about how you can get the biggest impact by focusing on persons with the highest needs.  We have assessment tools that efficiently help case managers know exactly what kind of intervention would be best for an individual.

In contrast, what is there for trying to connect a similar population for employment?  The very same innovators that attended this Workshop (who were more knowledgeable about employment programs than me) said that the system was backwards, encouraging programs to help people who were “job-ready” and easy to help.  And for those with higher needs, there was no tool to help service providers identify whether they would be good candidates for supported employment, job training, or something else entirely.

7. The Workforce Innovation and Opportunity Act is an opportunity

It’s a new piece of legislation that, among other things, requires states to develop new strategies, and look at the barriers of individual job seekers.  This is an opportunity for CoC leaders to get involved in the planning process, and have input on how to make better connections to employment programs.

8. There’s a lot of interest in a tool like the SPDAT, but with an employment focus

Maybe it’s something we should work on in the future.  What do you think?

Say What?

Here are the 12 most head shaking things said or written to me, that I have encountered in 2015 thus far:

1. “We have to have police with us on outreach. They have to do a warrant check and search people for weapons and contraband before we can speak to the client. It helps make sure we are speaking to the right people and not engaging in homeless criminals.”

Florida is a precious place. Sometimes they do amazing things in supporting people that are homeless (Hillsborough County Sheriff’s Office). Sometimes they do things that make me think all homeless persons are doomed in that state. When a street outreach worker says stuff like this to me, I can’t help but think I should find another job.

2. “We do home visits a bit differently. We have clients come to our office.”

This was shared with me by a service provider from the Northwest when I was at the Alliance conference in San Diego in February. I could not convince them that unless the visit actually occurred in a person’s home it was not technically a home visit. I said to them, “I eat ice cream a bit differently. I eat gummy bears.” They didn’t get it.

3. “Once we started doing drug testing at the shelter we found there were no clients with substance abuse issues anymore.”

Thank you service provider from Oklahoma that emailed me this gem in response to a blog I wrote a LONG time ago about substance use and housing services. In following up with them I learned that no one that uses substances is allowed in the shelter. They have no idea where those folks go. They suspect outside. So testing may keep ANYONE that uses substances out of the shelter (with or without substance use issues) but excluding them from entering does not mean that you have solved substance use issues in your community. You are just no longer serving those people.

4. “Anybody can stay in the shelter for 14 days. Beyond that, they have to apply for and be approved for the discipleship program.”

Oh St. Louis and the New Life Evangelistic Centre (which you may have read about on our FaceBook page or Twitter feed). Shelters are shelters. Shelters are not supposed to be places to recruit new members for your congregation. Staying in shelter should not be contingent upon agreeing to participate in your ministry. Faith-based shelters like this give other amazing, high-performing professional faith-based shelters a bad rap.

5. “Homelessness is the sin no one likes to talk about.”

I am scheduled to speak at a state conference in Kentucky in a few months. One of the people in hearing I am coming sent me a long email outlining things they wished I would talk about. Just about everything in the email I disagreed with. This line, however, made me laugh out loud. Homelessness is the lack of an address. It is not a sin. However, even it was I guess restitution for it would be to get housing so that they are no longer homeless and no longer, ahem, “sinning”.

6. “We have a 100% graduation rate from our transitional housing program.”

This time, the Midwest. But let me be clear. Of all the people that completed the two years in transitional housing (13 people out of 85 that started in the program), all 13 of them were considered successful graduates. Fun with numbers, I guess. The way I calculate it, it is a 15% success rate. But hey, if you are only counting those that made it all the way through, well, I guess all 13 that lasted to the end made it to the end – and therefore 100% of all people that finished the two years in transitional housing over the past two years were successful graduates.

7. “Every city needs a transformative campus.”

This was said to me by a strong supporter of Robert Marbut’s approach (see places like Haven for Hope in San Antonio) which co-locates all homeless services into one central location in a campus type setting. The part I find amusing is that I have never met a homeless service campus that actually works well. I mean, even Haven for Hope has used OrgCode’s services to help train staff on how to go about ending homelessness. Anyone been to Phoenix lately? The campus there is riddled with issues that are much more difficult to solve than when there is distribution of services throughout a community.

8. “We have some people that have had more than 2,500 nights of shelter stays and are coming out as moderate acuity. Clearly there is something wrong with your tool if these people aren’t coming out as needing PSH.”

This happened in Utah where statewide the tool is used to great results. When I asked the gentleman how long they had been using the tool it turned out to be less than a year. When asked what they had done to get people out of shelter before the tool was adopted he didn’t know. It is not a tool’s fault that people with moderate acuity have not gotten out of shelter sooner. Maybe it is the staff at the shelter’s fault for not figuring out how to house people with moderate acuity in the YEARS they have had to do so with the same clients night after night.

9. “Your training would be better if it was all free and online.”

Um…hmmm…better? But you’d lose out on the jokes! And Jeff, Tracy and I offer such incredible presence and charisma! Plus, OrgCode would no longer be viable as a business if we didn’t get paid to do at least some things. We already do oodles of stuff for free and give away loads for free (like the resources on our website). But hey, going under is good food for thought. We will consider that.

10. “You know that HUD and USICH hate the SPDAT and don’t support it.”

Nope. They don’t hate it. I checked. In person. Spoke with Matthew Doherty. And Ann Oliva. And Norm Suchar. They don’t endorse any tool – nor should they. But they don’t hate the SPDAT. In fact, they have been very responsive in helping us make sure subsequent versions are even more closely aligned to their policy objectives.

11. “How do you sleep at night knowing how rich you are getting off the lives of homeless people?”

First of all, person from Los Angeles, I don’t sleep well at night. Thanks for your concern. Usually it is because I am wondering what timezone I am in. Sometimes it is because of my depression. Sometimes it is because I lay awake feeling guilty I am not at home with my family. Sometimes it is because I can’t shut off my brain and I am trying to figure out the next important thing that OrgCode should do. But given that I am not rich and never will be rich, I can assure you that is not the reason for my sleeplessness. Again, though, thanks for your concern.

12. “I heard you get 17 cents per SPDAT entry in HIFIS [HMIS].”

Where do rumors like this even start? So just to clarify things once again: the SPDAT is free. It always has been. It always will be. People pay for the training. They don’t pay for the tool or any future updates. There is no annual licensing fee. There is no money changing hands between HMIS vendors and OrgCode – whether that is in Canada where HIFIS is used or across any of the US communities using their own HMIS.